Provider Demographics
NPI:1659838647
Name:BOEREMA AND THOMPSON COMPASSIONATE HEALTHCARE LLC
Entity Type:Organization
Organization Name:BOEREMA AND THOMPSON COMPASSIONATE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFRIECE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-339-2320
Mailing Address - Street 1:2700 WESTSIDE DR NW STE 103
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3699
Mailing Address - Country:US
Mailing Address - Phone:423-339-2320
Mailing Address - Fax:423-339-2321
Practice Address - Street 1:2700 WESTSIDE DR NW STE 103
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3699
Practice Address - Country:US
Practice Address - Phone:423-339-2320
Practice Address - Fax:423-339-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty